Art, When ReQuip was first prescribed for me, in conjunction with Sinemet CR, our HMO also rejected payment with a computer generated "not in our formulary" message. This was a few months after it's FDA approval. My neuro called the HMO and had a long, heated discussion with them. According to the information they had, ReQuip was a substitute for Sinemet, and they questioned why both were being prescribed. He was finally able to make them understand the benefits of it's use as an addition to Sinemet - mainly being able to keep the Sinemt dosage lower. He was angry too that he had to justify his prescription to people at the HMO who were not MDs. Maybe it needs to be presented in economic terms - that correct drug therapy now could help prevent or delay complications and more costly claims at at later date. Have there been any studies about this? I know I am fortunate to be dealing with a locally based HMO, a pharmacist who has taken a personal interest and a neuro who is willing to advocate for his patients. As you said, all of our individual drug prescription problems really need to be dealt with on a national policy level. Linda